As part of our Interoperability feature, we speak with interoperability specialists to go in-depth into the subject and to hear about some projects, challenges and learnings.
We hear from Servelec to explore some of their work and specifically the new platform from the company, Conexes.
To further explore the area we speak with Orion Health to hear about their customer projects, and how the company and its platform has supported healthcare teams through Covid-19.
We first spoke with Ben Wilson, Product Specialist Lead and INTEROPen Board Member at Orion Health.
Orion Health is a global company that develops software to drive efficiency in healthcare and improve healthcare outcomes. Their technology is used to power some of the leading shared care records throughout the UK and Ireland, including Connecting Care, based in Bristol, North Somerset and South Gloucestershire and the Northern Ireland Electronic Care Record.
How has Orion responded to the Covid-19 crisis?
Our immediate priority was to support our shared care record customers to ensure that appropriate patient information is available to the frontline staff that need it. This was especially important during the initial stages of the crisis when the healthcare system had the potential to become overwhelmed. Mid to late March saw us issue many new user licences to our customer base to make sure they could accelerate the roll out of those shared care records to additional users, for example ambulance workers and staff repositioned at some of the new Nightingale hospitals.
A second area we supported was assisting those same shared care record customers to make available additional important information to further support patient care during the crisis. Highlighting a patient’s Covid-19 infection status within the shared care record for example improves safety for both staff and patients and incorporating shared care plans into the record. On the latter, Connecting Care are now sharing patient ReSPECT forms from North Bristol NHS Trust, so professionals attending an individual know what their care preferences are including recommendations for emergency treatment, if an individual cannot express them.
A third area in which we have responded has been through the development of our Outbreak Management Solution. This brings together a range of our existing and proven products into a single cloud hosted solution. The solution enables the communication of test results to a patient, remote patient monitoring for those recovering from Covid-19 at home and analytic tools to track the Covid-19 patient cohort.
Can you tell me more about one of the customer projects that you’re currently working on with regard to interoperability?
Some exciting work has been taking place in Scotland regarding interoperability, in terms of helping patient information to flow across geographical boundaries.
Clinicians across five health boards in the West of Scotland, NHS Greater Glasgow & Clyde (NHSGGC), NHS Dumfries & Galloway, NHS Lanarkshire and NHS Ayrshire & Arran are able to look up patient information in each other’s regional shared care records, to better provide care for patients they encounter from neighbouring health boards. For example, at NHSGGC 55-60% of patients come from outside the NHSGGC catchment area, particularly those travelling for specialist treatment. These five health boards serve more than 2.2 million patients between them and the feedback we are receiving is that this patient information sharing is positively impacting around 10% of elective procedures. Just a basic level of interoperability using a mix of Orion proprietary standards with some industry standards is delivering huge value in terms of time saving and improved communication. The five regional shared care records are all built on Orion Health technology, but we’re now seeing shared care records powered by other providers joining the project.
In the North of Scotland, a single shared care record was launched last year covering NHS Highland, NHS Grampian, NHS Shetland, NHS Orkney, NHS Tayside and NHS Forth Valley. Recently some work has been to join the West of Scotland and North of Scotland solutions, through context launches and remote searches between some of the health boards, so it’s really positive to see this wider regional information sharing becoming a reality in Scotland, given that it’s such an ambition of the LHCRs here in England.
What’s coming up over the next few months?
We are quite heavily involved with the LHCR (Local Health and Care Records) programme to improve and coordinate individual care. It moves us on from the focus of the last 10 years or so of bringing together information across CCGs and comparably sized areas of perhaps 1 million patients or less with a lack of common standards to sharing information safely and securely across a larger population at a regional level using common and open standards. The LHCR programme is set to form the blueprint for how all sharing initiatives can be extended to a wider region.
We’re involved with the Wessex LHCR through our work with the Care and Health Information Exchange (CHIE) in Hampshire and the Isle of Wight and the Dorset Care Record (DCR). This LHCR region covers a population of 2.6million and will link both shared care records to provide a standardised and consolidated Wessex care record. Joining up health and care information across such a large geography brings some welcome opportunities to push interoperability forwards and operating to common standards including FHIR, SNOMED, dm&d and other national API standards developed by NHS Digital.
Joining up CHIE and DCR will be the starting point for the Wessex LHCR, so this will be our initial focus. In the future, we expect to be a part of national initiatives to join up information even more widely and between LHCRs, the use case being that if a patient from Wessex has an accident in London and needs to access care, the London LHCR will be able to access their record.
Because LHCRs are being built on open standards and open APIs, the programme will see the NHS take a big leap in maturity in the area of interoperability. Innovation on top of LHCRs becomes easier, with open APIs opening the door for third parties to build apps and new functionality on top.
What are the challenges with interoperability right now?
Adoption of interoperability standards has been slow and our health and care system is still largely dominated by proprietary interoperability where information is not easily and readily exchangeable; the landscape is incredibly complex in healthcare which has resulted in a lack of agreement on standard methods of information sharing. Healthcare interoperability continues to lag behind other industries such as banking which has solved some of the foundational interoperability issues that health care still struggles with.
Despite this complexity, we have seen many positive examples where progress is being made. We have start to see an adoption of FHIR APIs increasing within the supplier community which is encouraging, but FHIR is still an emerging standard. Those operating within the industry have been cautious to ensure it is a standard that will remain. It is also difficult to compel organisations to move away from their own proprietary standards due to technical complexities and costs.
Collaboration is another issue; interoperability needs to be a shared problem between all stakeholders in the healthcare eco system, making sure the national bodies such as NHS Digital and NHSX are engaged as well as standards bodies and vendors such as ourselves. Interoperability really needs to be driven with clear communication and more funding and established standards.
Organisations such as INTEROPen have been really helpful in recent years in uniting the industry around interoperability. INTEROPen is a collaboration of individuals, industry, standards organisations and health and care providers, who have agreed to work together to accelerate the development of open standards for interoperability in the health and social care sector. Follow them on twitter @INTEROPenAPI for information on their upcoming hackathons. The next will take the format of virtual hackathon due to take place on July 14th & 15th and focus on medications.
To conclude, there’s a huge amount of momentum behind interoperability right now and the Covid-19 crisis I believe will act as a catalyst to accelerate our interoperability agenda. There are still challenges to overcome, but with the right focus and collaboration I believe we’re at a new turning point.
We also spoke with Servelec to explore their interoperability platform and how the company is supporting health and care providers to realise joined-up digital care
“At Servelec we’re proud that joined-up digital care has always been at the heart of our mission. We recognise just how vital it is for clinicians and patients, councils and citizens alike. We’re committed to becoming the most interoperable supplier in digital care; a driving force for the change needed – because we know that joined-up care leads to better outcomes for those who need them the most.”
Could you tell us about your new platform Conexes?
“We power interoperability across healthcare and local government through Conexes, our cloud-based platform that enables a safe, secure environment to share data between systems and mobile apps to deliver an integrated approach.”
“Here’s our A-Z guide to some of the interoperable solutions made possible by Conexes, which are making a real difference in people’s lives:
- ADT: The ADT interface automatically updates other systems with information such as patient demographics, admissions, discharges and transfer details when it is changed in Rio, our EPR software. This helps avoid situations where patient information is out-of-date across systems, removes duplicate data and saves time.
- ADW: The Assessment, Discharge and Withdrawal integration connects the NHS MESH platform with our social care case management system, Mosaic – ensuring that social care teams are notified when a patient leaves hospital and their continuing needs can be met.
- AI virtual Assistants: Integrating EPR software with patient facing virtual assistants can help people self-manage appointments. Doing so reduces avoidable missed appointments and improves the patient experience.
- Allergies: Making sure every department or care setting can see information on a patients’ allergies in real-time can be life-saving. It can also help provide a better experience, as the patient doesn’t have to repeat their health history every time they see a different professional.
- Appointments: APIs enable trusts to communicate directly with patients via portals or other preferred methods, saving thousands in missed appointments. Diary information for care providers can also be made visible in multiple systems so staff don’t have to call round for availability.
- Assessments and clinical noting: With integrated mobile solutions, community workers can complete assessments and make clinical notes at the point of care. These are then transferred automatically in real-time into the EPR and shared with other systems, so there’s a single up-to-date view of the patient at all times.
- GP Connect: GP practices and authorised clinical staff can view GP practice clinical information and data between IT systems quickly and efficiently, giving them the tools they need to make better informed decisions for their patients.
- Interfaces/Information viewers: Through various interfaces, Conexes makes it possible to securely share information held in one system with another care setting, giving care professionals a better view of a person’s needs.
- Mobile: With integrated mobile technology, patient information captured in mobile apps such as Rio Mobilise at the point of care can be passed directly into a trust’s EPR in real-time. This can then be shared with other systems, creating a collaborative way of working.
- NEMS: We’re enabling the National Event Management System (NEMS) child health integration for Rio. Sending and receiving data to and from maternity providers, health visitor teams, blood spot screening labs and new-born hearing testers nationally, to streamline the management of Child Health.
- NRL for Mental Health Crisis Plans: Our National Record Locator integration allows mental health trusts to publish pointers to mental health crisis plans in the trust’s Rio system for patients in distress. Ambulance services can access crisis plans through the NRL at the point of care, allowing them to tailor next care steps according to the best interests of the patient.
- Orders and results: Bi-directional integration between EPR software and systems for requesting pathology testing and results reporting provides the ability to view a patient’s tests results and to create an order for a new test, without accessing different systems.
- Patient summaries: Through pre-configured patient summary APIs it’s possible to share key patient information between systems safely and securely, preventing re-keying, saving time and reducing errors.
- Shared care records: We help Integrated Care Systems join up mental, community, child health and social care records with acute hospitals, GP practices and ambulance services. Through a range of interfaces to third party systems, patient data can be accessed seamlessly without having to switch system, streamlining processes and saving time so professionals can do what they do best, care for others.”
“We call it Digital Care, and we’re by your side.”